Culture, blood
Facility: Hospital District #6 Patterson Health Center
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $68
- Cash Discount Price: $60
- vs. Medicare Baseline: 6.59x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $10.32 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 659% of the Medicare baseline (a markup of 559%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $36 - $38 | 349% |
| UnitedHealthcare | $68 - $75 | 659% |
| Providers Care (Wppa)-All Plans | $131 | 1269% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood), the facility's cash median price of $60.00 is lower than the negotiated rates paid by major insurers like UnitedHealthcare ($68.00) and Blue Cross Blue Shield ($36.00 to $38.00). This suggests that for patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price directly could result in lower total costs compared to using insurance, as the negotiated rate exceeds the cash price. However, patients should verify their specific plan's allowed amount and deductible status before scheduling, as some commercial contracts may still result in higher out-of-pocket expenses depending on the individual policy terms.
The facility's Medicare benchmark rate of $10.32 serves as the objective baseline for evaluating pricing fairness, highlighting that commercial rates are significantly higher than the federal government's cost-based standard. While the facility is a Critical Access Hospital in Anthony, KS, with government ownership, the data does not provide specific county or state average comparisons for this service code. To ensure you are receiving the best possible rate, it is recommended to request an itemized bill before payment to identify any unbundled charges or services not rendered, and to inquire directly about prompt-pay discounts that could further reduce the final amount owed.